Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MDR-5742 | HI |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD176505 | OR |
NPI | 1104053388 |
---|---|
Provider Name | Dr. Krister Paul Freese |
First Address | Honolulu, HI 96813-2421 |
Second Address | Honolulu, HI 96813-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 05/10/2020 |